Prevalence and associated factors of intimate partner violence against pregnant women in urban areas of Japan: a cross-sectional study.

BACKGROUND: Intimate partner violence (IPV) against pregnant women is associated with many negative maternal and fetal outcomes and is a common public health problem all over the world. However, the issue has not been fully explored in Japan. This study aimed to explore the prevalence and risk factors of IPV against pregnant women in urban areas of Japan. METHODS: This study was a secondary data analysis of a cross-sectional survey that was conducted on women beyond 34 weeks' gestation in five perinatal facilities in urban areas of Japan, from July to October 2015. The sample size was calculated to be 1230. The Violence Against Women Screen was used for IPV screening. Multiple logistic regression analysis was used to calculate the adjusted odds ratio (AOR) with 95% confidence interval (CI) for risks of IPV while adjusting for confounding factors. RESULTS: Of the 1346 women who participated in this study, 180 (13.4%) were identified as experiencing IPV. Compared to those who did not experience IPV (n = 1166 (86.6%)), women experiencing IPV had higher odds of being single mothers (AOR = 4.8; 95%CI: 2.0, 11.2), having lower household income (< 3 million yen, AOR = 2.6; 95%CI: 1.4, 4.6; ≥ 3 million yen and < 6 million yen, AOR = 1.9; 95%CI: 1.2, 2.9), having junior high school education background (AOR = 2.3; 95%CI: 1.0, 5.3) and being multipara (AOR = 1.6; 95%CI: 1.1, 2.4). CONCLUSIONS: 13.4%, or about one in seven women, experienced IPV while pregnant. This high proportion indicates the need for policy to address the issue of violence against pregnant women. There is an urgent need to build a system for the early detection of victims that offers appropriate support to prevent the recurrence of violence while encouraging victim recovery.

Breastfeeding support and barriers to women with gestational diabetes mellitus: a nationwide cross-sectional survey of hospitals in Japan.

BACKGROUND: Despite the benefits of breastfeeding for women with Gestational Diabetes Mellitus (GDM) and their infants, breastfeeding is less likely to be performed by this group. This study aimed to examine the current levels of implementation of breastfeeding support to women with GDM in Japan and to clarify barriers to promoting breastfeeding among this population. METHODS: A 25-item questionnaire was developed by the authors to investigate the current levels of implementation of breastfeeding support for women with GDM provided in hospitals, and to explore barriers for promoting breastfeeding among these women. The questionnaire was sent to all 1046 hospitals facilitating childbirth in Japan. Descriptive statistics were used to analyze the quantitative data, and content analysis was used to analyze qualitative data from the open-ended questions. RESULTS: All 296 respondents were included in this study. Regarding breastfeeding support, 95.2% of the respondents provided general information on breastfeeding to GDM women during antenatal midwife consultations. However, the benefits of breastfeeding for preventing type 2 diabetes were addressed by only 48.0%. Likewise, although follow-up services (e.g., telephone support or breastfeeding consultations) were conducted in 88.9% of hospitals, only 50.7% of hospitals informed women that breastfeeding decreases the risk of developing type 2 diabetes after GDM. Regarding barriers, seven categories and 20 subcategories about promoting breastfeeding for women with GDM were extracted and abstracted into the following three themes: Barriers associated with mother and infant, Barriers associated with health professionals, and Organizational barriers. CONCLUSIONS: In Japan, most hospitals that responded provided general breastfeeding support from the antenatal to postpartum periods. However, the benefits of breastfeeding in terms of preventing the incidence of type 2 diabetes following GDM were insufficiently communicated to women with GDM. Furthermore, there were numerous barriers to promoting breastfeeding among women with GDM.

Experiences of being screened for intimate partner violence during pregnancy: a qualitative study of women in Japan.

BACKGROUND: Intimate partner violence (IPV) is physical, sexual or psychological violence by a current or former intimate partner. IPV threatens women's health, and during pregnancy women are more vulnerable to violence. Therefore, IPV screening has been recommended during antenatal care; however, health care providers have expressed concern about the negative impact on women and therefore have been reluctant in conducting IPV screening. Consequently our objective was to investigate pregnant women's experiences of reading and completing an IPV screening questionnaire. METHODS: Semi-structured interviews were conducted with postpartum women who had received IPV screening during pregnancy to investigate their experiences using the IVP Violence Against Women Screen (VAWS). Qualitative data were analyzed based on content analysis. RESULTS: A total of 43 women participated in this study. There were eight (18.6%) women positive for IPV screening during pregnancy. Content analysis for all participants revealed three themes: necessity, acceptability and optimality. 'Necessity' referred to benefits for women from IPV screening, and was supported by three categories: 'redefining the relationship', 'promoting IPV awareness' and 'opportunity to initiate support'. 'Acceptability' of IPV screening was also supported by three categories: 'comfortable', 'quickly completed' and 'difficulty'. 'Optimality' meant IPV screening during pregnancy was appropriate timing for women who had been screened as either positive or negative. CONCLUSIONS: The majority of women, including women experiencing IPV, had positive responses to IPV screening during pregnancy. Future diffusion of IPV screening requires safe environments for IPV screening and improved awareness of health care providers towards IPV.

Principles of care for women experiencing intimate partner violence: Views of expert Japanese health professionals and advocates.

In Japan, interventions for Intimate Partner Violence (IPV) in the health care setting are rare, partly due to Japanese cultural norms that marginalize women's IPV experiences. A thematic analysis of narratives of eight Japanese health professionals who are experts in IPV care identified shared core values and practices that have guided their development of culturally relevant IPV interventions: supporting women's autonomy to define what is at stake for her, appreciating unique trajectories and timing for recovery, and practicing shared decision-making. These shared practices may be essential for training health professionals to respond to IPV in Japan and elsewhere.

A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers.

BACKGROUND: The Japan Academy of Midwifery developed and disseminated the '2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)' for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives. METHODS: This study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011. RESULTS: The overall response was 255 of the 684 institutions (37%). Of the total responses 46% were hospitals, 26% were clinics and 28% were midwifery birth centers. Few institutions reported perineal massage education for 'almost all cases'. Using 'active birth' were all midwifery birth centers, 56% hospitals and 32% clinics. Few institutions used water births. The majority of hospitals (73%) and clinics (80%) but a minority (39%) of midwifery birth centers reported 'not implemented' about applying warm compress to the perineum. Few midwifery birth centers (10%) and more hospitals (38%) and clinics (50%) had a policy for valsalva as routine care. Many hospitals (90%) and clinics (88%) and fewer midwifery birth centers (54%) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21%) and clinics (25%). All respondents used fundal pressure as consistent with guidelines. Not many institutions implemented the hands and knees position for correcting fetal abnormal rotation. CONCLUSIONS: This survey has provided new information about the policies instituted in three types of institutions guiding second stage labor in four metropolitan areas of Japan. There existed considerable differences among institutions' practice. There were also many gaps between reported policies and evidence-based Guidelines for Midwives, therefore new strategies are needed in Japan to realign institution's care policies with evidenced based guidelines.

A survey of screening and support systems for socially high-risk pregnancies at obstetric facilities in Japan.

AIM: To clarify the state of screening and support systems for socially high-risk pregnant women at obstetric facilities across Japan and identify the characteristics of facilities related to the implementation of screening. METHODS: This cross-sectional study used a self-administered questionnaire. Participants were managers of hospitals, clinics, and midwifery birth centers handling deliveries in 47 prefectures across Japan. The questionnaire comprised items regarding the characteristics of participants and their facilities, service provision related to socially high-risk women available at the facility, the number of specified pregnant women (tokutei ninpu) per year, methods of screening, and support systems within the obstetric facilities. Descriptive statistics and multivariate logistic regression analysis were performed using IBM-SPSS version 24 for the association between facility characteristics and screening practices for socially high-risk pregnant women. RESULTS: Valid responses were received from 716 of 2512 obstetric facilities. Rates of specified expectant mothers per annual number of deliveries were identified as follows: perinatal medical centers (2.7%), general hospitals (1.6%), obstetrics and gynecology hospitals (1.0%), and clinics (0.8%). A total of 426 facilities (60.6%) reported screening all expectant mothers to identify socially high-risk pregnant women. Multiple logistic regression analysis revealed that facility characteristics and service/care provision related to screening practices included availability of in-hospital midwife-led care and in-hospital midwifery clinics (adjusted odds ratio 1.61; 95% CI [1.30, 1.47]), one-on-one care by midwife (1.73; 95% CI [1.15, 2.59]), multidisciplinary meetings within the facility (1.70; 95% CI [1.14, 2.56]), follow-up support systems after discharge (1.90; 95% CI [1.17, 3.09]), and participation in the regional council for children in need of protection (2.33; 95% CI [1.13, 4.81]). CONCLUSIONS: Approximately 60% of surveyed obstetric facilities screen for socially high-risk women. Increasing service provision at facilities may be necessary to implement screening.

Projections of maternal mortality ratios in Bangladesh.

Background: The objective of this study was to predict when Bangladesh would achieve Sustainable Development Goal Target 3.1, which is to reduce the maternal mortality ratio (MMR) to less than 70 per 100 000 live births. Methods: We used secondary data from the 1993 to 2017 Bangladesh Demographic and Health Surveys and other sources to project the MMR until 2060 under several scenario assumptions using an autoregressive moving average model with exogenous variables (ARMAX). Explanatory variables were selected based on the three delays model, and a reference forecast and four practical scenarios were simulated: Scenario 1 assumed a 4% annual increase in institutional deliveries, Scenario 2 followed the national goals, the reference forecast and Scenario 3 varied in terms of district-wise increase rates (Scenario 3 had a lower rate of increase), and Scenario 4 assumed minimal changes in institutional deliveries. Results: Scenario 1 was the earliest, with an MMR of <70 per 100 000 live births in 2026. Scenario 2 would meet the target of <70 per 100 000 live births in 2029. The reference forecast had the third lowest MMR, with 69.78 per 100 000 live births (95% prediction intervals (PI) = 32.44 to 107.11) in 2049. Although the MMR for Scenario 3 decreased slowly, it would not reduce below 70 per 100 000 live births by 2060. Scenario 4, which had the highest MMR, also resulted in the MMR not reducing below 70 per 100 000 live births by 2060. Conclusions: To increase the institutional delivery rate and reduce the MMR, as in Scenarios 1 and 2, it is necessary to improve the institutional delivery rate in regions with low institutional delivery rates. Additionally, health facilities need to provide appropriate quality medical care to increase the institutional delivery rate and contribute to a decrease in the MMR, as shown by the results of this study.

Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period.

BACKGROUND: There are several Cochrane systematic reviews looking at postpartum haemorrhage (PPH) prophylaxis in the third stage of labour and another Cochrane review investigating the timing of prophylactic uterotonics in the third stage of labour (i.e. before or after delivery of the placenta). There are, however, no Cochrane reviews looking at the use of interventions given purely after delivery of the placenta. Ergometrine or methylergometrine are used for the prevention of PPH in the postpartum period (the period after delivery of the infant) after delivery of the placenta in some countries. There are, furthermore, no Cochrane reviews that have so far considered herbal therapies or homeopathic remedies for the prevention of PPH after delivery of the placenta. OBJECTIVES: To assess the effectiveness of available prophylactic interventions for PPH including prophylactic use of ergotamine, ergometrine, methylergometrine, herbal therapies, and homeopathic remedies, administered after delivery of the placenta, compared with no uterotonic agents as well as with different routes of administration for prevention of PPH after delivery of the placenta. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013), The Food and Drug Administration (FDA) (USA),  Medicines and Healthcare Products Regulatory Agency (MHRA) (UK), European Medicines Agency (EMA) (EU), Pharmaceuticals and Medical Devices Agency (PMDA) (Japan),  Therapeutic Goods Administration (TGA) (Australia), ClinicalTrials.gov, Current Controlled Trials, WHO International Clinical Trials Registry Platform (ICTRP), University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; Japan), Japan Pharmaceutical Information Center Clinical Trials Information (Japic-CTI; Japan), Japan Medical Association Clinical Trial Registration (JMACCT CTR; Japan) (all on 30 April 2013) and reference lists of retrieved studies SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing prophylactic ergotamine, ergometrine, methylergometrine, herbal therapies, and homeopathic remedies (using any route and timing of administration) during the postpartum period after delivery of the placenta with no uterotonic agents or trials comparing different routes or timing of administration of ergotamine, ergometrine, methylergometrine, herbal therapies, and homeopathic remedies, during the postpartum period after delivery of the placenta. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and the methodological quality of trials, extracted data using the agreed form. Data were checked for accuracy. MAIN RESULTS: Five randomised studies involving 1466 women met the inclusion criteria. All studies were classified as having an unclear risk of bias. Two studies (involving 1097 women) compared oral methylergometrine with a placebo, and one (involving 171 women) compared oral methylergometrine with Kyuki-chouketsu-in, a Japanese traditional herbal medicine. The remaining two studies (involving 198 women) did not report the outcomes of interest for this review. None of the included studies reported primary outcomes prespecified in the review protocol (blood loss of 1000 mL or more over the period of observation, maternal death or severe morbidity). Overall, there was no clear evidence of differences between groups in the following PPH outcomes: blood loss of 500 mL or more (risk ratio (RR) 1.45; 95% confidence interval (CI) 0.39 to 5.47, two studies), amount of lochia during the first 72 hours of the puerperium (mean difference (MD) -25.00 g; 95% CI -69.79 to 19.79, one study), or amount of lochia by four weeks postpartum (MD -7.00 g; 95% CI -23.99 to 9.99).The Japanese study with a relatively small sample size comparing oral methylergometrine with a Japanese traditional herbal medicine found that oral methylergometrine significantly increased the blood haemoglobin concentration at day one postpartum (MD 0.50 g/dL; 95% CI 0.11 to 0.89) compared to herbal medicine. Adverse events were not well-reported in the included studies. We did not find any studies comparing homeopathic remedies with either a placebo or no treatment. AUTHORS' CONCLUSIONS: There was insufficient evidence to support the use of prophylactic oral methylergometrine given after delivery of the placenta for the prevention of PPH. Additionally, the effectiveness of prophylactic use of herbal medicine or homeopathic remedies for PPH is still unclear as we could not find any clear evidence. Trials to assess the effectiveness of herbal medicines and homeopathic remedies in preventing PPH are warranted.

Effectiveness of an educational program for clinical educators to promote novice midwives' clinical judgment: A cluster randomized controlled trial.

BACKGROUND: There has been little research on education for clinical educators and particularly on education to promote clinical judgment. Therefore, the purpose of this study was to examine the effectiveness of an educational program for clinical educators to promote the clinical judgment of novice midwives during delivery. METHODS: A cluster randomized controlled trial was conducted in which a facility was considered a cluster. Eleven facilities (44 participants) were randomly assigned to the intervention group with the educational intervention and 10 facilities (33 participants) to the control group without the educational intervention. Inclusion criteria were midwives who had become clinical educators within five years. The educational program consisted of e-learning and a seminar. The primary outcome was educational skills. The secondary outcomes were attitude, knowledge, and satisfaction. Data on the satisfaction was collected only for the intervention group. Intention-to-treat and multi-model analyses using a random intercept model were used to analyze data. St. Luke's International University ethics review committee approved the study (20-A016). RESULTS: No differences in baseline characteristics of participants and facilities were noted. There was no significant difference in educational skills scores at post-test between the intervention and control group (MD 1.88, 95 % CI [-0.55-4.31]). There was no significant difference in attitude scores at post-test between the two groups (MD 2.38, 95 % CI [-0.76, 5.51]). The knowledge scores at post-test were significantly higher in the intervention group (intervention group 2.68 ± 0.26, control group 1.57 ± 0.25; MD 1.10, 95 % CI [0.41-1.80], p = .002). CONCLUSION: The intervention group improved only in knowledge scores, with no effect on educational skills or attitudes compared to the control group. It is necessary to evaluate the effectiveness of the program by conducting long-term follow-up and evaluation.

Intimate partner violence and the situation of women experiencing intimate partner violence during the COVID-19 pandemic: A qualitative study of Japanese clinician views.

AIM: Intimate partner violence (IPV) is a major global threat to women's health. Stay-at-home orders during the coronavirus disease 2019 (COVID-19) pandemic were associated with an increase in IPV. The purpose of this study was to clarify IPV and the situation of women experiencing IPV during the COVID-19 pandemic in Japan. METHODS: A semi-structured interview was conducted with five healthcare providers who gave support to women experiencing IPV during the COVID-19 pandemic. All interviews were audio-recorded, transcribed and analyzed in accordance with thematic analysis methodology. RESULTS: Two categories concerning IPV and the situation of women experiencing IPV during the COVID-19 pandemic emerged from analysis of interviews: (1) the possibility that IPV might change during the pandemic; and (2) barriers that prevent women getting support. "Possibility that IPV might change during the pandemic" consisted of three subcategories: "Male partner takes his stress out on her"; "Male partner forced her out of the home"; and "Conflict occurred more easily at home". "Barriers that prevent women getting support" had four subcategories: "Difficulty in accessing outside support"; "Restricted access to get care due to financial difficulties"; "Lack of support from her family"; and "Women experience a loss of energy". CONCLUSIONS: During the COVID-19 pandemic, there were barriers to provide support for women despite increased IPV. Healthcare providers should support women using effective methods to protect women's health and safety.

An E-Learning Program for Continuing Midwifery Education on Handling High-Risk Abuse Cases: A Pretest-Posttest Design.

It is essential to equip midwives and nurses working in the perinatal period with comprehensive knowledge and awareness regarding child abuse prevention. However, most midwives and nurses in Japan do not have the opportunity to learn about abuse prevention during their basic education. We aimed to develop an e-learning program to assist obstetric midwives and nurses in acquiring the knowledge needed to provide support and handle cases with a high risk of abuse, as well as to assess the program's usefulness. This study employed a single-group pre-post design; e-learning served as the intervention. Seventy-one obstetric midwives and nurses were recruited. The program's usefulness was the difference between the participants' pretest and post-test knowledge and efficacy scores. The score data were analyzed using the t-test. A paired t-test revealed that the post-test scores of knowledge and efficacy were significantly higher than those of the pretest, with a large effect size (d = 1.71). Platforms where basic knowledge on how to respond to high-risk abuse cases are lacking in nursing education; thus, this e-learning program is recommended for nurses working in the perinatal field throughout Japan. This educational opportunity for perinatal midwives and nurses will increase awareness and contribute to abuse prevention.

Identifying Core Items of the Japanese Version of the Mother-to-Infant Bonding Scale for Diagnosing Postpartum Bonding Disorder.

The Japanese version of the mother-to-infant bonding scale (MIBS-J), a self-report of postpartum bonding disorder, is used in clinical settings for screening postpartum bonding disorder at various time points. However, its psychometric properties, particularly measurement invariance, have rarely been reported, and the validity of comparing scores across time points and sex is unclear. We aimed to select and validate the MIBS-J items suitable for parents at three time points. Postpartum mothers (n = 543) and fathers (n = 350) were surveyed at 5 days, 1 month, and 4 months postpartum. All participants were randomly divided into two subgroups, one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses. Measurement invariance of the best model was tested using the entire sample, between fathers and mothers, and across the three observation periods. A three-item structure (items 1, 6, and 8) extracted through EFAs showed acceptable configural invariance. This model was accepted for scalar invariance between fathers and mothers and for metric invariance across the three time points. Our findings suggest that the three-item MIBS-J is sufficient for diagnosis of postpartum parental bonding disorder through continuous observation for at least 4 postpartum months, in order to detect the priority of parents who need support.

Evaluation of the effect of a midwife-led online program using cognitive behavioral therapy for pregnant women at risk for anxiety disorder in Japan: A pilot randomized controlled trial.

AIM: This study aimed to conduct a pilot randomized controlled trial (RCT) to examine the appropriateness and feasibility of a midwife-led cognitive behavioral therapy (CBT)-based, three-session program delivered remotely to pregnant women at risk for anxiety disorders. METHODS: The study design was a pilot RCT. Outcome was the difference between the two groups in the change in generalized anxiety disorder-7 (GAD-7), Kessler6 (K6) and Edinberg Postnatal Depression Scale (EPDS) etc. Recruitment was conducted from August 2020 to July 2021 in clinics and web-based survey monitors in Japan, with follow-up through November 2021. RESULTS: This program involving 63 pregnant women were administered. Although the intervention was remote, a total of three sessions was completed during pregnancy. The change in GAD-7 scores from pre- to 1 month postpartum, was mean -1.77 in the intervention group and mean -0.97 in the control group, with a p-value of .521, indicating no significant difference between the two groups, although GAD-7 scores were lower in the intervention group. The change in K6 score from pre- to 1 month postpartum, was mean -3.55 in the intervention group and mean -1.62 in the control group, with a p-value of .168, indicating no significant difference between the two groups, although the intervention group showed a greater decrease. In particular, in primiparas, the change in GAD-7 scores in the intervention group was large, and some expressed a desire for a postpartum session, suggesting that a follow-up session after delivery may be effective. In multiparas, the control group showed an increase in both GAD-7 and K6 scores from late pregnancy to 1 month postpartum, while the intervention group showed a decrease in scores. CONCLUSION: The program was implemented using CBT conducted by midwife, anxiety decreased in primiparas. In future RCTs, it was suggested that additional postpartum sessions may be effective. TRIAL REGISTRATION: UMIN Clinical trial registry ID: UMIN000040304.

Complementary and alternative medicine use by pregnant women in Japan: a pilot survey.

BACKGROUND: Complementary and alternative medicine (CAM) are popular among women, and are used during their pregnancy in Japan. This study aimed to survey the prevalence of CAM use by healthy pregnant women as a health-care prescribed therapy or self-care and to investigate the factors associated with CAM use in Japan. METHODS: In this cross-sectional study, pregnant women after 34 weeks of gestation were asked to respond to a questionnaire at the clinic or online. The questionnaire comprised questions on the participants' characteristics and their use of CAM for therapy and self-care. Descriptive statistics were calculated in the analyses, and bivariate and multivariate logistic analyses were performed to evaluate the associations between factors and CAM use. RESULTS: A total of 394 women responded from three hospitals, two clinics, and two midwifery birth centers. CAM was received as treatment by practitioners during pregnancy by 75 women (19.0%). The following therapies were used: traditional Chinese medicine (7.9%), chiropractic (6.9%), moxibustion (6.4%), and acupuncture (5.3%). One or more types of therapy were used as self-care by 348 women (88.3%). Highly used CAM for self-care were: folic acid supplementation (75.4%), other supplements (51.5%), herbs (20.8%), and yoga (19.0%). Multiple logistic regression analyses revealed that the factors associated with CAM use as a therapy were midwifery birth centers for planned childbirth settings (adjusted odds ratio [AOR] 3.64, 95% confidence interval [CI] [1.69-7.83]) and pregnancy complications diagnosed (AOR 2.46, 95%CI [1.38-4.39]). The factors associated with CAM use for self-care were age 30-39 years (AOR 4.48, 95%CI [2.14-9.73]) and over 40 years (AOR 3.92, 95%CI [1.10-13.91]), junior college education or above (AOR 2.30, 95%CI [1.18-4.51]), and primiparas (AOR 3.82, 95%CI [1.86-7.86]). The most common source of information was the "Internet" (43.8%). CONCLUSIONS: Approximately 20% of Japanese pregnant women received CAM as therapy by practitioners, and the related factors were: tended to have baby at midwifery birth center and pregnancy complications. Almost 90% of respondents used CAM as self-care and the related factors were: older, had a higher educational level and tended to be primiparas. They used the Internet as their main source of information about CAM. Health care providers need to provide evidenced-based information on CAM and to help decision making to ensure safe and effective CAM utilization by pregnant women.

Effects of e-learning on the support of midwives and nurses to perinatal women suffering from intimate partner violence: A randomized controlled trial.

AIMS: To examine the effects of e-learning on intimate partner violence (IPV) knowledge, preparatory/reinforcing behaviors for supporting IPV victims, and IPV screening of midwives and nurses. METHODS: Participants were randomly assigned to the intervention group (IG: e-learning) and control group (CG: no e-learning). The primary outcome was the mean change in knowledge score. The secondary outcomes were the mean number of types of practiced preparatory/reinforcing behaviors and the proportions of participants who practice screening. Unpaired t tests were performed in intention-to-treat analysis. RESULTS: Of the 88 participants, 45 were randomly assigned to the IG and 43 to the CG. For the post-1-test, the IG had a mean change in the knowledge score of 8.5 points with a significant difference from the 1.4 points in the CG (mean difference [MD] 7.1, 95% CI [4.1, 10.1]). The mean change between the pre-test and the post-2-test was significantly larger in the IG (7.9 points) than in the CG (1.3 points) (MD 6.6, 95% CI [3.3, 9.9]). The mean number of types of practiced behaviors at the post-1-test and post-2-test was significantly higher in the IG than in the CG (MD 1.4, 95% CI [0.1, 2.8]). There was no significant difference in the proportions of participants who practice screening between the two groups postintervention. CONCLUSIONS: The e-learning effectively improved knowledge and promoted preparatory/reinforcing behaviors.

Cognitive behavioral therapy in perinatal mental health: An overview of systematic reviews.

AIM: The purpose of this study was to determine whether cognitive behavioral therapy (CBT) started in pregnancy can prevent depression and anxiety. METHODS: We conducted an overview review by selecting systematic reviews (SRs) that compared CBT with usual care, no CBT, or interventions other than CBT in perinatal women. We restricted the review to studies that included randomized controlled trials. The results of included SRs were descriptively integrated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Seven SRs met our eligibility criteria. One SR was limited to CBT interventions, whereas others included psychoeducation and interpersonal psychotherapy. There was some variation in the number of sessions and timing of CBT, and whether there was a postpartum intervention. Five SRs showed that CBT reduced depression compared with usual care, an educational intervention, or no intervention. One SR that analyzed the effect on anxiety found that psychotherapy, including CBT, reduced anxiety compared with usual care or no intervention. DISCUSSION: CBT starting from pregnancy may be effective as a preventive intervention for postpartum depression and anxiety, although the degree of effectiveness varied. CONCLUSIONS: This overview review aimed to clarify whether CBT is effective in preventing depression and anxiety from pregnancy. CBT may be effective in reducing perinatal depression and anxiety.

The NVP QOL Questionnaire: Psychometric properties of the self-report measure of health-related quality of life for nausea and vomiting during pregnancy.

Aim: The Nausea and Vomiting of Pregnancy Quality of Life (NVP QOL) Questionnaire is a self-report measure of health-related QOL for nausea and vomiting during pregnancy. This study determines the best fitting factor structure for the NVP QOL Questionnaire and explores its measurement invariance in terms of observation time and parity. Methods: A test-retest study of pregnant women was conducted at Gestational Weeks (GWs) 10-13 (T1: N = 381) and 1 week later (T2: n = 128) at one hospital and five clinics with the NVP QOL and the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE). Exploratory and confirmatory factor analyses were performed to compare different factor structure models and evaluate measurement invariance of the best fitting model between two time points and between primiparas and multiparas. Concurrent validity of the NVP QOL was clarified by correlations with the PUQE, Sheehan Disability Scale, and other scales. Results: The one-factor model had the best fit. This factor structure model was acceptable up to the factor invariance level for two time points and up to the factor mean level for primiparas versus multiparas. Correlations between NVP QOL, PUQE, and Sheehan Disability Scale scores were strong. Women with higher NVP QOL scores were more likely to lose weight, have lower daily fluid intake, have reduced fluid and food intake since pregnancy began, and receive outpatient or inpatient treatment. Conclusion: The one-factor structure and measurement invariance of the NVP QOL at different times and parities were demonstrated, suggesting that the NVP QOL can be used to evaluate primiparas and multiparas in a longitudinal study.

Prevalence and risk factors for hyperbilirubinemia among newborns from a low-risk birth setting using delayed cord clamping in Japan.

AIM: Neonatal jaundice is a common problem among infants. Among the several risk factors are East Asian race and delayed cord clamping. Birth centers manage low-risk term deliveries using physiological management, which may include delayed cord clamping. This study aimed to investigate the occurrence of hyperbilirubinemia, a pathological process of jaundice, and its risk factors among neonates born at a Japanese birth center. METHODS: This was a retrospective cohort study. Data were collected from March 2006 to October 2014 from healthy mothers and neonates at a birth center in a metropolitan area of Japan. Demographic data and background factors of hyperbilirubinemia, including blood and transcutaneous values of jaundice, were collected and statistically analyzed. RESULTS: Of the 1,211 neonates analyzed, 4.7% exceeded the standard transcutaneous bilirubin value, and 1.8% needed phototherapy. Multiple logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) was used to identify the risk factors of hyperbilirubinemia, which were found to be cephalohematoma (OR = 30.18, 95% CI 5.63-161.69), delay of meconium elimination (OR = 2.66, 95% CI 1.28-5.51), previous history of phototherapy of siblings (OR = 10.28, 95% CI 3.53-29.92), and primiparity (OR = 4.55, 95% CI 2.59-8.02). CONCLUSIONS: In low-risk Japanese neonates delivered at a birth center expected to practice delayed cord clamping, the rate of neonates requiring phototherapy was not high compared to previous studies, and the identified risk factors of hyperbilirubinemia were related to bilirubin metabolism.

Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial.

BACKGROUND: Japanese infants have relatively higher risk of anemia and neonatal jaundice. This study aimed to assess the effects of delayed cord clamping (DCC) on the incidence of anemia during early infancy in low-risk Japanese term infants with planned exclusive breastfeeding for 4 months. This study also aimed to explore the effects of DCC on neonatal jaundice. METHODS: We conducted an open-label, parallel-arm, multicenter randomized controlled trial of DCC (clamping the cord after more than a minute or pulsation stops) vs. early cord clamping (ECC; clamping the cord within 15 s) at one birth center and two clinics in Japan. Low-risk pregnant women planning to have a vaginal birth and to exclusively breastfeed and term singleton infants delivered in cephalic presentation were included in this study. The primary outcome was spectrophotometric estimation of hemoglobin at 4 months. Secondary outcomes were anemia incidence at 4 months, four outcomes related to neonatal jaundice, hematocrit levels, and related outcomes. RESULTS: Overall, 150 pregnant women were recruited. Participants (N = 138) were randomly allocated to two groups (DCC n = 68, ECC n = 70). There were no significant differences between the two groups in spectrophotometric estimation of hemoglobin at 4 months: mean difference = 0.1 g/dL, 95% confidence interval - 0.14, 0.35, DCC 12.4 g/dL, ECC 12.3 g/dL. Only the hematocrit levels on days 3 to 5 were significantly higher in the DCC group than in the ECC group: DCC 57.0%, ECC 52.6%, mean difference = 4.4, 95% confidence interval 2.61, 6.20. There were no significant differences in other secondary outcomes, including outcomes related to neonatal jaundice. CONCLUSION: Among low-risk Japanese term infants with planned exclusive breastfeeding, DCC showed no significant effects on spectrophotometric hemoglobin levels at 4 months compared with ECC. We observed significantly higher hematocrit levels on days 3 to 5 in infants who underwent DCC, while these levels were within the normal range. Jaundice outcomes remained similar to those of infants who underwent ECC. Although a larger sample size is required to assess the effects of cord clamping on neonatal jaundice, DCC may prevent anemia in newborn infants. TRIAL REGISTRATION: UMIN-CTR; UMIN000022573, 06/01/2016 - retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000023056.

Continuous interprofessional collaboration for women with gestational diabetes mellitus: A cross-sectional survey in Japan.

AIM: This study aimed to identify the current situation of interprofessional collaboration for gestational diabetes mellitus (GDM) management in Japan including the professionals involved, the collaboration methods employed, and the barriers perceived by nurses and midwives. METHODS: This nationwide cross-sectional survey of 1,046 total hospitals facilitating childbirth in Japan used an original 60-item questionnaire to investigate GDM management practice through interprofessional collaboration. The questionnaire required one responder to be a midwife or nurse who was familiar with the management practices for GDM women in their respective hospitals. Quantitative data were analyzed using descriptive statistics, and framework analysis was conducted for qualitative data collected by open-ended questions. RESULTS: All 308 respondents (response rate 29.4%) were included. The professionals included in interprofessional collaboration were limited, and the only strategy used for interprofessional collaboration by a majority (91.5%) of hospitals was medical charts. There were 50.8% of hospitals that provided postpartum GDM follow-ups and 54.5% of hospitals that did not engage in external collaboration for GDM management. The barriers to interprofessional collaboration extracted were seven categories and 23 subcategories, which were aligned within the following units of analysis: individual, team, organization, and community. CONCLUSIONS: This survey shows that interprofessional collaboration, including support for GDM postpartum follow-up in Japan remains insufficient. Furthermore, nurses and midwives perceive numerous barriers to interprofessional collaboration for continuous GDM management at the individual, team, organizational and community levels.